A meta-analysis of studies examining the effectiveness of MDMA-assisted therapy in treating post-traumatic stress disorder (PTSD) found that these treatments were associated with reduced symptom severity. These were also associated with improved function and reduced dissociative symptoms. The paper is european neuropsychopharmacology.
3,4-Methylenedioxymethamphetamine, also known as MDMA, ecstasy, or Molly, is a psychoactive drug that alters mood, cognition, emotional openness, and social connectedness. It primarily affects brain chemicals such as serotonin, dopamine, and norepinephrine. MDMA is an illegal drug in many jurisdictions because its use can cause high blood pressure, overheating, dehydration or hyperhydration, anxiety, panic, sleep disturbances, and low mood after use.
But scientists are also studying its potential use in treating mental disorders. One such potential use is MDMA-assisted therapy. MDMA-assisted therapy is a type of psychotherapy in which MDMA is administered in a controlled clinical setting in the presence of a trained therapist. The idea is that MDMA reduces fear and defensiveness while increasing trust and emotional openness, which may make it easier for some people to process traumatic memories. It is being studied specifically for the treatment of post-traumatic stress disorder.
Study author Natalia E. Juarez Otero and colleagues note that while many studies have been conducted investigating the effects of MDMA-assisted therapy, significant regulatory and methodological challenges affecting psychedelic research threaten the validity of the conclusions drawn from these studies. They conducted a meta-analysis aimed at addressing these limitations, focusing only on randomized controlled trials of MDMA-assisted therapy.
Researchers looked at the effects of this therapy on PTSD symptoms and overall daily life in adults suffering from PTSD. They focused on randomized controlled trials. This is because research designs in this category apply the highest level of experimental control and have the highest chance of valid results.
The study authors searched a range of research publication databases, including Scopus, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, Web of Science Core Collection (WoS), ClinicalTrials.gov, PTSDpubs (PILOTS), PsycINFO, and CINHAL, for randomized controlled trials that addressed their topic of interest. This search found 14 studies that included: Just what these authors were looking for.
Six of these studies were secondary analyzes of clinical trials and their results were interpreted qualitatively, whereas eight studies contained sufficient data for quantitative analysis. These eight studies were conducted primarily in North America, with additional sites in Europe and Israel. The total number of participants across all eight studies was 387 (range 2–104 per study). Sixty-seven percent of participants were female, and the average age of participants was 40 years.
Overall results showed that MDMA-assisted therapy was not only associated with a reduction in PTSD symptom severity compared to the control group, but also with a reduction in dissociative symptoms and improved overall functioning. There was no clear evidence that it was effective against symptoms of depression.
“The current study results suggest that MDMA-AT (MDMA-assisted therapy) may warrant further investigation as a potential treatment for PTSD. However, large, high-quality RCTs (randomized controlled trials) with active controls and long-term follow-up are needed to determine its efficacy,” the study authors concluded.
This study contributes to the scientific understanding of the potential of MDMA-assisted therapy in the treatment of PTSD. However, the study authors issued a serious caveat regarding the quality of the data. Most of the studies they analyzed showed a high risk of bias in outcome measurements, mainly due to failures in ‘blinding’. Because MDMA causes clear psychoactive effects, both patients and therapists usually knew who received the real drug and who received the placebo, resulting in a large expectation bias that could artificially exaggerate positive results.
As a result, the overall certainty of the evidence was rated as ‘very low’. Some studies had very small sample sizes, and few followed long-term patient outcomes (more than 1 year after treatment), further limiting the strength of the scientific evidence provided. The authors also noted that most studies were funded and conducted by a single research group, increasing the risk of publication bias.
The paper, “Efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for post-traumatic stress disorder: A systematic review and meta-analysis of clinical and functional outcomes,” was authored by Natalia E. Fares-Otero, Yuki furkawa, Marit Sijbrandij, Stefan Leucht, Eduard Vieta, Pim Cuijpers, Mathias Harrer, and Soraya. Seedat.
